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Main drivers behind changes in the ways that public services have been delivered over the past 30 years It was during the first half of the last century when two World Wars spurred the action of government to control its national resources. This was followed by the protective role that public administrations extended as they also had a key role in the other areas such as economic, social and cultural areas. It was also at this time when the role of the Welfare State was dominant especially after World War II (Public Service Delivery). One of the main drivers of change in the ways that public service has been delivered was the increasing cost that became so big leading to significant indebtedness forcing the industrialized nations to come up with major reforms in their public sectors (Aucoin and Savoie, 1998 as cited in Public Service Delivery). These reforms were composed of a progressive disengagement of the state from the activities of the different sectors like the natural resources management. It was then able to mobilize its mission around key sectors such as health, social security, employment and justice (Beauregard, 1994 as cited in Public Service Delivery).
Taxpayers welcomed this move because they were less burdened in terms of payment. They saw that the government was now able to manage public property more effectively (Guay, 1997 as cited in Public Service Delivery). Governance has become a buzzword of the recent years as regards to how services are delivered to the people. According to the World Bank, governance is the institutional capability of public organizations to provide public and other goods demanded by a countrys citizens or their representatives in an effective, transparent, impartial, and accountable manner, subject to resource constraints (48). The role of participatory decision-making has been emphasized in the article Improving Governance, Managing Conflict and Rebuilding State, where conflict management would be facilitated if the ethnic diversity of South Africa would be given the opportunity to collaborate with the government. Acknowledging various ethnicities in governance opens up opportunities for the political and economic well-being of the country.
Many times, the political and managerial changes are also related to the different changes in public service performance. Even the leadership change affects service performance variables. (Does new leadership make a difference to public service performance and does it make things better or worse? ). An example is this issue is when everyone is involved in the delivery of health care and they are directly or indirectly involved in the business of health care. Customer service, marketing, public relations, and education can be provided by all staff members. Filling out charge slips, keeping departmental service statistics, as well as providing direct care (the product sold) are business aspects of revenue-generating departments. Hospital managers have a responsibility to meet needs of clients, staff and the organization.
Because the needs of those served may be in conflict, there is a potential for the manager to experience conflicts of values. A conflict occurs whenever the manager cannot fulfill equally their duty toward all those to whom they have a responsibility. When values conflict, which choice of action should be taken? Should the manager advocate for the needs of the client? Give priority to the staff members needs? Give up something for the department to help the organization serve clients another way?
These are the questions with moral implications. Solutions to moral questions require organized introspection. The plethora of problems is actually ranging from lack of sufficient staff, increase in the cost of medicine, to increase in the number of people with no access to health insurance. This is becoming a typical article in major periodicals and journals (Gore, 2000). Despite the general inability of Americans to have access to health care, there is still a need to actually distinguish the level of quality between the provisions of health care from private institutions and the health care services of the public health care facilities.
This paper argues that the lack of funds and resources of the government has made private health care facilities better in terms of service and quality of health care treatment. One of the major criticisms that have been given for public health care facilities is their inability to respond to sudden surge of clients or patients (Public Health Foundation). Public health facilities are criticized for not being able to respond appropriately in terms of sudden epidemiologic outbreak. The main course of action is to call the state health department or the Center for Disease Control in order to provide an investigation over the sudden surge or occurrence of a disease. This reaction is logical but it is quite inefficient. The role of the local health department has not been considered in this specific case.
In addition to this, there will be a delay in response if there will be no action taken within the local health unit (Rinsky 2005). These kinds of responses coming from public health care facilities can have a negative effect in terms of timely delivery of cure and preventive measures. In addition to this, the inefficient steps undertaken may cost hundreds of lives in the process. When public health officials are asked about the capacity of the hospitals especially in acute care, they know and they admit that there are indeed some possibilities that in the event of an outbreak, many of these public health facilities would not be able to cater to all the demands. There are several problems that have been pointed out in terms of the lack of capacity of public health care facilities. First, there are few hospital beds that could actually accommodate acute cases (Heymann 2001).
Secondly, there is a shortage in the number of staff, particularly of nurses and the facility would not be able to respond sufficiently in time of sudden surge in the demand (Bates 2002). In fact, many of the nurses in public hospitals are already taking around 16 -hour shifts in order to cater to the number of patients availing of health care services. Finally, insufficient funding usually disables them from accommodating critical operations (Navarro 2003). These kinds of problems of public health care facilities make the patient quite vulnerable to certain treatments and health care that are already way below the quality that the patients deserve. Doctors for example, will have to take private practice as well just so they could accommodate the low salary provided in many health care facilities of the government (Heymann 2001). In effect, the capacity of the hospital or health care facility is greatly challenge in terms of the number of health care support and staff, doctors and surgeons, and the over-all bed capacity and equipment capacity.
Many nurses for example, admit that the increase in the number of hours of shifts could actually put a great risk for patients. Nurses in their exhaustion may fall into an unintentional accident that may cause human lives. Ethical dilemmas arise at all levels in the hospital set up. People, whether employer or employee, may face situations in their work or dealings with other people in which ethical dilemmas arise. The individuals in these cases are faced with ethical questions in their relations with patients, employees, and members of a larger society. More often than not, the answers to these questions are difficult because it involves weighing of values.
Often than not, conflicting values in a given situation are not capable of compromise. One has to choose one over another (Neal, William, 2000). Sometimes, the ethically correct course of action is clear, and hopefully individuals act accordingly. But the answers are often not simple. The dilemma is most commonly presented when ethical concerns come into conflict with the practical demands of running the hospital.
Example is a situation where the choice involves a trade-off between lowering ones personal values in exchange for increased organizational or personal profits (Neal, William, 2000). Clearly, ethics in hospitals present a unique and real problem with its challenge at the same time. Meanwhile, in other countries, the authors of Governance and Growth in Sub-Saharan Africa, discussed the shift of Sub-Saharan countries from purely authoritarian to that of democratic types of government and how these forms of government have helped or have obstructed the economic growth of these countries that had been traditionally authoritarian. (Ndulu and Oconnel). In the authoritarian regime, there had been tendencies to promote personal or specific groups interests as opposed to the general welfare. The authors stressed that pluralism in governance provides impetus to economic as well as political growth (Ndulu and Oconnel).
As governance talks about transparency and accountability of those in the government, the article of Lambsdorff provides insights on how weak bureaucracy relents general welfare to corruption such that capital inflows and productivity are sacrificed because of the notion that there exists no law and order. It has been emphasized that in order to increase productivity, there ought to have reforms in the public sector stabilizing the bureaucracy, improving its quality, and widening civil liberties. These reforms are in accord with the needs of good governance. In acknowledging the importance of making governance not just an affair of the government alone but of the various sectors of the society, decentralization- from political, to administrative to fiscal- has been considered as one of the mechanisms by which countries could achieve better governance (Ndegwa). Although the progress of decentralization in Africa has been moderate, the reforms that these countries initiated have placed the groundwork for better service delivery and improvement in governance as a whole. Indeed, the government must modernize and improve the quality of its public service delivery methods (Ethier, 1994 as cited in Public Service Delivery).
Thus, it is important to note that there are three main factors that pressured the administration to make reforms so that it will create a real reinvention of government (Heeks, 1999 as cited in Public Service Delivery). These are 1) a critical level of national debt; 2) IT growth and the globalization of the market; and 3) Better informed and more demanding citizens. Works Cited List Beer, Michael. Organizational Behavior and Development. (n.
d. ) Accessed Aug. 8, 2008 at: < web 'organizational% 20 behavior% 20 affects% 20 organization n'>. Beauregard, Claude. "Les Finances publique's du Quebec et le disengagement de l'Etat au cours des angeles 1980. " In L'Administration publique - Diversite de ses probleme's, complete de sa gestion. Gerard Ethier, publisher, Quebec: Presses de l'Universite du Quebec, 1994, p. 479 - 502. Current Status of Collaboration in Selected Countries web Does new leadership make a difference to public service performance and does it make things better or worse?
Accessed Aug. 8, 2008 at: web Ethier, Gerard. L'Administration publique - Diversite de ses probleme's, complete de sa gestion. Quebec: Presses de l'Universite du Quebec, 1994. Griffin, Ricky W.
and Anne M. OLeary-Kelly, ed. The Dark Side of Organizational Behavior. San Francisco: Jossey-Bass, 2004. Accessed Aug. 8, 2008 at: < web >. Guay, Marie-Michele.
Performance et secteur public - Replies, en jeux et paradoxes. Quebec: Presses de l'Universite du Quebec, 1997. Heeks, Richard. "Reinventing Government in the Information Age. " In Reinventing Government in the Information Age: International Practice in IT-Enabled Public Sector Reform, . Richard Heeks, publisher, London: Routledge, 1999, p. 9 - 21.
Heymann, D. 2001. Global Public Health Systems Must Be Improved to Combat Infectious Diseases. Journal of Public Health 15, (3): 212 - 234. Infotrac Academic ASAP database, via Victor Valley College Library, Accessed Aug. 8, 2008 at: web Lambsdorff, Johann Graf.
How Corruption Affects Economic Development. Aug. 8, 2008 at: < web Development. pdf>. Navarro, V. 2003.
Americas Class Structure Has Created an Unfair Health Care System. International Journal of Health Services 23, (3): 212 - 234. Infotrac Academic ASAP database, via Victor Valley College Library, Accessed Aug. 8, 2008 at: web Neal, William. Ethical Conduct in the Business World: A Trust to be Kept.
Feb. 2000. From Brigham Young University Hawaii website. Accessed Aug. 8, 2008 at: < web >. Ndegwa, Stephen N. Decentralization in Africa: Emerging Trends and Progress. Public Findings. 229 (2003).
Aug. 8, 2008 at: < web english / find 229. pdf>. Ndulu, Benno J. and Stephen A. OConnell.
Governance and Growth in Sub-Saharan Africa. Journal of Economic Perspectives. 13. 3 (1999): 41 - 66. Aug. 8, 2008 at: < web >. Public Service Delivery. Accessed August 7, 2008 at: web Rinsky, Robert A. 2005. : A Message from the Editor. Public Health Reports 120, (2): 107 - 108.
Infotrac Academic ASAP database, via Victor Valley College Library, Accessed Aug. 8, 2008 at: web World Bank. Improving Governance, Managing Conflict and Rebuilding State. Can Africa Claim the 21 st Century? Washington: The International Bank for Reconstruction and Development/ The World Bank, 2000. Aug. 8, 2008 at: < web >.
Free research essays on topics related to: ethical dilemmas, organizational behavior, health care, care facilities, academic asap
Research essay sample on Ethical Dilemmas Academic Asap
